Echocardiographic left ventricular stroke work index: An integrated noninvasive measure of shock severity

Abstract

Background Echocardiographic findings vary with shock severity, as defined by the Society for Cardiovascular Angiography and Intervention (SCAI) shock stage. Left ventricular stroke work index (LVSWI) measured by transthoracic echocardiography (TTE) can predict mortality in the cardiac intensive care unit (CICU). We sought to determine whether LVSWI could refine mortality risk stratification by the SCAI shock classification in the CICU. Methods We included consecutive CICU patients from 2007 to 2015 with TTE data available to calculate the LVSWI, specifically the mean arterial pressure, stroke volume index and medial mitral E/e’ ratio. In-hospital mortality as a function of LVSWI was evaluated across the SCAI shock stages using logistic regression, before and after multivariable adjustment. Results We included 3635 unique CICU patients, with a mean age of 68.1 ± 14.5 years (36.5% females); 61.1% of patients had an acute coronary syndrome. The LVSWI progressively decreased with increasing shock severity, as defined by increasing SCAI shock stage. A total of 203 (5.6%) patients died during hospitalization, with higher in-hospital mortality among patients with lower LVSWI (adjusted OR 0.66 per 10 J/m2 higher) or higher SCAI shock stage (adjusted OR 1.24 per each higher stage). A LVSWI <33 J/m2 was associated with higher adjusted in-hospital mortality, particularly among patients with shock (SCAI stages C, D and E). Conclusions The LVSWI by TTE noninvasively characterizes the severity of shock, including both systolic and diastolic parameters, and can identify low-risk and high-risk patients at each level of clinical shock severity.

Sex differences in left ventricular stroke work and cardiac power output per unit myocardium relate to blood pressure in apparently healthy adults

“…The LVSW and CPO are parameters of overall LV function, but the LVSWM and CPOM represent the performance of unit myocardium or myocardial workload. Previous studies on the LVSW index, CPO index, or peak CPOM quantified with stress echocardiography has displayed important prognostic values of these parameters in cardiovascular disease [35][36][37][38][39][40][41][42]. Thus, it is hoped that this work will stimulate further research on these important measures of LV myocardial performance to improve the accuracy of cardiac function assessment and therefore to optimize clinical decisions in cardiovascular disease.…”

Cardiovascular Hemodynamics in Mice with Tumor Necrosis Factor Receptor - Associated Factor 2 Mediated Cytoprotection in the Heart

“…Similar observations were made in patients with major adverse cardiovascular events (Tona et al, 2021). Also, it has been shown that decreased LV stroke work index is associated with diminished LV systolic and diastolic function in cardiac intensive care unit patients (Jentzer et al, 2022). Also, we found that stroke work is significantly lower in the in the TRAF2 mice perhaps indicating a diminished cardiac function.…”

Update on cardiogenic shock: from detection to team management

“…Similarly, invasive data from arterial pulsatility and temporary mechanical circulatory support platforms can add to the understanding of the clinical scenario. There is a paucity of data regarding the combination of invasive and noninvasive parameters, timing of evaluation, and adequate correlation with clinical and echocardiographic findings for CS and these questions merit further study [25 ▪▪ ].…”